MiniMedical School

“Simples” are defined as the use of a single herb or plant in a medicinal way. The use of simples pre-dates the written record and continues in wide use today. The 2016 US sales of simples are greater than $7.5 billion annually. That does not take into consideration the increase in sales due to the recent legalization of cannabis.

Cannabis-History-The oldest written record dates from 2,600 years ago, and the historical record goes back more than 8,000 years. In 1840, Western medicine formally recommended the use of cannabis for muscle spasm and seizures. Cannabis was added to the 3rd edition of the US Pharmacopoeia (USP) shortly thereafter for pain relief, seizure prevention and insomnia. In 1937, the Marijuana Tax Act made cannabis illegal and in 1942 the AMA removed it from the USP.

Pharmacology- There are more than 100 different cannabinoids primarily in the flowers, leaves and bracts of the female plant. The main psychoactive component is Δ9-THC, and the next most common compound is cannabidiol (CBD) which has quite different properties. There are CB1 receptors for these cannabinoids that regulate appetite, mood, memory, fear extinction, motor responsiveness, posture, and are also present in GI tract, fat cells, liver, and muscle. The CB2 receptors, interestingly, are on microglia (brain), osteoclasts and osteoblasts (bone).

Products- Cannabis products are smoked, vaporized, applied topically and taken orally. Generally speaking, 30% of sales are edibles, 23% resin 20% oil. The standard dose of THC is 5-10 mg and is established by individual states. The average smoked joint yields 8 mg THC but the potency of US plants has increased steadily in recent years.

The FDA approved Pharmaceutical forms are Marinol, Cesamet and Syndros. These are prescribed primarily for nausea and vomiting from chemotherapy and for loss of appetite due to the wasting syndrome of AIDS. Twenty seven other countries also use an oral spray, Sativex, (THC:CBD 1:1), for Multiple Sclerosis. Compassionate use is permitted for Epidiolex, a CBD oil, for certain types of epilepsy.

Therapeutic Applications– The most common indication for cannabis use is chronic pain, followed by nausea and vomiting of chemotherapy, spasticity, epilepsy, Tourette’s syndrome, traumatic brain injury, anxiety, post-traumatic stress disorder and sleep. When used for pain, there is an observed >60% reduction in opioid use.

Adverse Effects and Contaminants-There is one subtype of testicular cancer which is increased with chronic cannabis use, and there is a suggestion that there is an increased risk of cancer in the children of women who used cannabis while pregnant. There is no compelling data on lung cancer in chronic smokers, but chronic cough is common. There is an increase in unintentional overdoses, primarily in children, from edibles. Adults overdose unintentionally from repeated doses because the first perceived onset of action of an edible can be as much as 2 hours from the time of ingestion. An additional concern is the impact of cannabinoids on driving ability. There is at least a 10% increase in motor vehicle accidents under the influence of cannabis. Impaired driving ability is worthy of intensive research to fully assess the impact of wider medicinal and recreational use.
Contaminants are also a major concern as they are a common and under-recognized cause of chronic disease. Common contaminants are pesticides, solvents used in the making of oil extracts, heavy metals (the cannabis plant likes to concentrate cadmium and copper from the soil), lead or glass beads (added to increase weight as cannabis is usually sold by weight), bacteria and molds. Synthetic cannabinoids that are sprayed on the original plant material, such as Spice, have unpredictable mood effects and have caused permanent brain damage and renal failure.Recommendations: When buying cannabis products, insist on organic (not currently regulated or certified by CCOF or the USDA) and all hemp oils should be supercritical CO2 extracted and not extracted with hexane or benzene.

Hops-Interestingly, in the same family as cannabis: Family: Cannabaceae. Hops are the primary flavoring in beer. Hops are also used as a stand-alone herb for stomach upset, sleep and as a diuretic. A poultice of hops was traditionally used for arthritis, and it can be blended with valerian, passion flower and skullcap and served as a tea for anxiety.Dandelion- is primarily used as the roasted root for upset stomach, as a diuretic and also to stimulate bile secretion. Leaves are a highly nutritious spring green.Calendula- is used for topical would healing and is available as a save.Arnica flower- is also a topical for wounds. Over 300 arnica products in Germany alone.Cranberry- is a preventive for urinary tract infection.Milk Thistle seeds-is for restoring liver after hepatitis and fatty liver cirrhosis.Willow bark- is the source for aspirin with the same indications.Witch Hazel- is astringent, anti-oxidant and for wounds.Elderberry (Sambucus)-decreases the severity and duration of flu and colds. (flower and berry)Echinacea-Treats early colds and flu.Lavender-Essential oil is used for anxiety as aromatherapy or as a patented oral capsule (Lavela). Flowers for aromatherapy pillows for sleep.Sassafras and sarsaparilla (root beer)-is a mouthwash, topical antiseptic and for fever.

The Precision Medicine Initiative is a National US research program that is different than anything we have seen before. The Initiative applies massive computing power to analyze complex genetic relationships, aggregate massive amounts of data and discover new approaches to healthcare. Precision Medicine customizes the medical treatment to the person as well as the specific disease. https://allofus.nih.gov/

Three specific applications are:

Pharmacogenomics (the right drug, the right dose)

Assessment of individual genetic cancer risk

Individual tumor profiling for chemotherapy

Pharmacogenomics:

Drugs are “digested” differently by everyone. It is not just a matter of breaking down the original compound. There are an infinite number of speeds, routes and byways for metabolic pathways to progress. Fortunately, some of those pathways are well described and have a clear genetic basis.

A cheek swab will deliver enough DNA for analysis of the essential enzymes, and an individualized highway can be constructed. The formal name for one of these metabolic families is Cytochrome P450 isoenzymes. Some are fast, some are slow and some go to odd places. Any of these variations can result in too much, too little or abnormal byproducts of a drug causing side effects and a lack of therapeutic effect. These individualized pathways are specifically measured by pharmacogenomics testing. When the report is resulted, there will be a list of preferred drugs, those that need modification and others that should be completely avoided. Because this is genetic, the results last a lifetime.

Right now, this testing is used only in special circumstances. Preliminary data show a dramatic decrease in office and ER visits with correct pharmacogenomics testing. Very soon, no one will be prescribed a drug that they are not profiled to safely consume.

Genetic Cancer Risk Analysis:

There are many reasons to pursue genetic cancer risk testing and the situations are as varied as the individuals tested. Evaluation starts with the family history of cancer. If there is a clustering of cancer in the family, especially early onset cancers, then genetic testing is recommended. If a person is identified as carrying the gene, then increased screening and early diagnosis and treatment can be lifesaving. Knowing the genetic risk also allows screening of other family members, which can be additionally life-saving.

Most people are familiar with BRCA testing for hereditary breast and ovarian cancer. This testing was pioneered by Myriad Genetics. There are now many more identified genes that increase cancer risk and there are now several companies offering genetic testing and counseling services. A cutting-edge local initiative is the Project DNA, a website and initiative, created by a local gastroenterologist, Dr. Dan Luba. This has a wealth of well-organized information. There are fifteen individual syndromes listed as well as educational videos and a smart family history calculator. This can be accessed at: http://theprojectdna.com/about/.

Tumor Profiling:

Not all cancer that occurs in a single organ, such as the breast, has the same behavior. Some are lazy and some are aggressive. This tendency can be tested genetically. For example, HER2/neu is a protein that, when present in excess, affects breast cancer management. First, it changes prognosis, indicating a more aggressive tumor. Secondly, it allows a targeted therapy with Herceptin. Only HER2 expressing tumors are treated with drugs that specifically target HER2. There are other HER2/neu targeting agents in clinical trials.
A tumor can also change its genetics over the course of therapy and a sophisticated change of chemotherapy may be lifesaving. Rapid genetic profiling of the current tumor genetics would allow immediate re-design of chemotherapy and is aggressively researched at many major universities.

Resources: (endless)

Pharmacogenomics on the net: https://ghr.nlm.nih.gov/primer/genomicresearch/pharmacogenomics

Consider participating in the All of US Research Program of the Precision Medicine Initiative.
https://allofus.nih.gov/

Fitness historically referred to the ability to complete a task. What we now mean by “fitness” has no formal definition and it is highly context dependent. A concrete fitness goal could be to achieve a specific percent body fat (26-31% body fat is normal for women, and 18-22% for men), or the ability to hike to the top of Garland Park.

One hundred years ago, fitness meant being able to haul wood and carry water and walk to the town when the horse was lame. Our century has a very different definition of activities of daily living. Given our 2st century environment, today’s fitness would be defined as the ability to sit in front of a computer or television for hours!

A recent article in the cardiology journal “Circulation” reported that most adults spend 6-8 hours a day in sedentary activities, and adults over 60 years of age averaged 9 sedentary hours a day. Sitting time increases risk of metabolic syndrome, diabetes, cardiovascular disease and all-cause mortality. Just two hours of extra TV time increases diabetes risk 14%. Fortunately, just 2 hours standing or walking decreases diabetes risk 12%. There is a similar increase in cardiovascular disease from prolonged sitting. All-cause mortality also increases with the degree of sedentary behavior, with the most sedentary (70% of the time) showing a 6 times increased death rate.

The physiology underlying increased morbidity and mortality involves many endocrine glands as well as muscles, fat and inflammatory and endothelial cells. One of the most important and well researched risks is the reduction in insulin sensitivity with sedentary behavior. Glucose from meals is intended to go to the cells for immediately available energy. If there is local resistance to the transfer of glucose into the cells, the level of glucose in the blood increases. If blood glucose goes past a certain threshold, it initiates a cascade of negative events specifically, increased inflammation, oxidative stress, endothelial dysfunction and an increase in sympathetic tone.

How do you get folks to increase their activity when there are so many attractive distractions? There is research support for two interventions: changes in the workplace environment, and use of smart phone apps that remind users to take a walk break. It is ironic indeed that the very technology that caused the problem is being used to solve the problem! Even regular short breaks for a walk reduce risk.

Bones and Muscles

Astronauts can lose as much as 5% of their bone density per month. An extended deployment in space may return them with a bone density close to osteoporosis. This can be mitigated by exercising as much as 2 hours a day while they are weightless. Bones respond to muscle pull even in low gravity environments. Muscle pull and gravity are the two main forces that maintain bone density.

Muscle pull on the bone stimulates bone to remodel. This constant remodeling is essential for good quality bone. There are two types of cells in bone-osteoblasts and osteoclasts. The former build bone and the latter dissolve bone. Usually they are in balance, but if the osteoblasts decrease activity, bone loss ensues. Physical activity is essential for good bone quality, but if there is a loss of bone structure, then it is essential to modify the exercises to prevent micro fractures. Exercises that involve flexion (forward lean) and rotation of the spine are particularly dangerous. You will have to say good bye to your crunches, toe touches, and toe touches with twist. Similar benefits can be obtained by modifying these exercises to maintain an upright posture. It is essential to work with an instructor who is trained to adapt exercises to individuals with low bone mass.

The beneficial effect of gravity can be optimized by maintaining an upright posture. Slumping compresses the anterior aspect of the vertebral bone, and can cause micro-fractures. Slumping and lateral rotation also increase pressure on the intervertebral disc and can even cause it to slip, possibly causing a nerve compression. Slumping also reduces the area for your lungs to expand, and for your bowls to digest. Tai Chi Chuan, some Yoga and the Bones for Life program apply the beneficial effect of posture on bone density.

The Turtle Wins

Whatever you decide to do for exercise, pick something that you enjoy and start out slowly. One ligament tear will put you back six months. Be very mindful of your feet if you are fast walking or hiking. See an excellent podiatrist if you have any foot pain. Chronic foot problems decrease your activity level and always result in the accumulation of a few unwanted pounds.

If you choose to start weight training, start with light weights and more repetitions. A good rule of thumb is to use a weight that fatigues you by about the 15th repetition.

Make it social. You will be more consistent if you are gathering with friends. If you enjoy your private time, you can exercise with an audio book. Just be sure it is a page-turner!

“Our mission is to use knitting and other therapeutic creative activities to improve wellbeing generally, but also to complement medical treatments in the self-management of long-term health conditions. We are working closely with academics and clinicians, and as a direct result, therapeutic knitting and therapeutic knitting groups are being formally acknowledged by leading clinicians and academics for their benefits in mainstream healthcare. We have been successfully using knitting therapeutically in the NHS since 2006, so have a wealth of knowledge to share. This is just the beginning. Low-cost activity groups have the potential to not only revolutionise our individual lives but healthcare systems worldwide because they provide an affordable means of long-term support, motivation and monitoring.” Accessed 10/6/2017 at www.stitchlinks.com

The Benefits of Knitting for Personal and Social Wellbeing in Adulthood: Findings from an International Survey. British Journal of Occupational Therapy 76(2):50-57 · February 2013

“This study aimed to identify the benefits of knitting for individuals’ personal and social wellbeing as a prerequisite to investigating its therapeutic use. Method: An online survey was conducted through an internet knitting site. Responses were received from 3,545 knitters worldwide. Quantitative data were analysed statistically to establish relationships and differences among variables and qualitative data for key themes. Results: Respondents came from a virtual community of knitters. The majority were female white adults and frequent knitters, who commonly reported knitting for relaxation, stress relief and creativity. The results show a significant relationship between knitting frequency and feeling calm and happy. More frequent knitters also reported higher cognitive functioning. Knitting in a group impacted significantly on perceived happiness, improved social contact and communication with others. Conclusion: Knitting has significant psychological and social benefits, which can contribute to wellbeing and quality of life. As a skilled and creative occupation, it has therapeutic potential – an area requiring further research.”

Stitch’N Bitch. These groups started more than 100 years ago. Women get together for needle crafts and social commentary. I leave the rest to your imagination.

Learning new things-words, music and language:

There are multiple research studies showing that learning a second language creates new neural networks. Learning a second language increases grey matter density and white matter integrity. This effect is observed in all age groups, including the “elderly”.

There are also many studies that show that listening to and making music also contributes to preservation and enhancement of cognitive capacity. Recent research (Rogenmoser et al., 2017) showed that compared to non-musicians, musicians have lower BrainAGE scores as determined by MRI studies of the brain. Amateur musicians stayed younger than professional musicians, an effect attributed to the stress of professional work or to over practicing a single skill.

In “Apollo’s Gift” Altenmuller reviews the physiological data on music therapy, extending the benefits from the craft to include the subjective pleasure of music. The pleasure one finds in music “provokes motions and emotions”. There are changes in the areas of the limbic system which mediate emotion, motivation and long term memory. This pleasurable component not only makes music listening more frequent, but actually facilitates neurotransmission and new connections.

The Tasmanian Healthy Brain Project found that 93% of the education participants, 50-79 years of age, showed an increase in cognitive reserve compared to a control paired group that did not attend adult university courses. Locally, adult learning experiences are available at: Gentrain (http://www.gentrain.org/) at MPC, and the OLLI at CSUMB (http://olli.csumb.edu/).

Exercise with support groups:

Research on exercise robustly supports increased neuroplasticity and prevention of age related decline in mental capacity. We will return to the science in greater depth in December.

However wonderful exercise is for your brain, there is little benefit if you cannot be consistent. Some of the best ways to exercise and keep exercising is adding a social component. Specifically, join a group. There are many groups, and you need to pick one that suits your temperament and exposes you to people you enjoy. One great idea to find compatible people is to search on Meetup (www.meetup.com) for a hiking, running or sports/fitness group.

If you are a bit of a loner, you can meet your coach on line. There are many apps and on line programs. My Fitness Pal is one of the best apps and integrates with many of the advanced pedometers and sleep moitors. The sharing of success stories is enlightening and motivating, as you experience other people’s joy in achieving their goal.

Stress management with Forest Bathing:

Stress destroys neurons, and stress management is essential to healthy brain aging. Forest bathing therapy was developed in Japan. A forest bath is a short walk in the forest with time for viewing and appreciating the surrounding trees.
The Forest Therapy Association (http://www.natureandforesttherapy.org/) has an excellent website. They have a research page summarizing the current studies, and also have a program to train guides. Overall, forest bathing reduces stress hormones, lowers blood pressure and improves immune function.

Locally Mary Ann Rowe, PhD, will be leading some preliminary walks. If you are interested, you can contact her at at 831-373-1017.

The doctor of the future will give no medicine, but will interest his (her) patients in the care of the human frame, in diet, and in the cause and prevention of disease.” Thomas Edison

What is Food? Protein, fats and carbohydrates=calories. Add a vitamin pill and you are all set, right? Not quite. Here is a list of the high nutrient value plants and their participating phytochemicals, which are not included in that simple formula.

Eat five different kinds of fruits and vegetables every day to recapture the disease preventing phytochemicals missing in the American diet. Taking vitamin and mineral pills will not prevent the diseases associated with a processed-food diet. Scientists cannot formulate into pills nutrients they haven’t yet discovered”. –Dr. James Duke, US Dept. of Agriculture

Step One: Start with Good ingredients:

Water: The Environmental Working Group just released its tap water analysis. Cal Am is in legal compliance, but has levels of arsenic, bromodichloromethane, chloroform, hexavalent chromium, dibromochloromethane, dichloroacetic acid, trichloroacetic acid, total trihalomethanes and above optimum health levels. Optimum health levels are not the same as legal limits. These chemicals are all carcinogens. https://www.ewg.org/tapwater/#.WY3VUVWGPIU

The fundamental error in safety testing is made by testing isolated chemicals for toxicity. The synergistic toxicity of simultaneous low doses of hundreds chemicals over a life-time is not evaluated.

The DASH Diet is endorsed by the National Institute of Health and research reports a BP reduction of 10.7/5.2 mm Hg, which is comparable or exceeds medication results. More information is at: https://www.nhlbi.nih.gov/files/docs/public/heart/dash_brief.pdf

This table of the pharmacological actions of foods was prepared by a leading cardiologist:

EXAMPLE 2-APPLYING WHAT YOU KNOW ABOUT HEART DISEASE: Mediterranean Diet, including the right olive oil. It is the one that tastes peppery. Learn more at the Quail and Olive, Carmel Valley Village. Exercise and social support are essential.

EXAMPLE 3-APPLYING WHAT YOU KNOW ABOUT DIABETES: Refined Sugar is actually a drug and is part of the triad of compounds (salt, sugar, fat) that the processed food industry uses to assure a return customer. Check out: Salt Sugar Fat: how the food giants hooked us by Michael Moss

Lifestyle management is a more complex undertaking than just taking a daily pill. Change in diet, exercise, weight reduction, stress management, supplements are all part of this integrated treatment system.

August is National Coffee Month! Research supports many benefits of coffee and tea drinking, just hold the sugar! Research at the Coffee Institute: http://vanderbilt.edu/ics/coffee-news/ shows a reduction in Parkinson’s disease, colon cancer, liver cancer and Type II Diabetes.

“Rather than focusing on more product for less price, we must focus on replenishing the soil. The weakening of our nation’s soil contributes to an unavoidable chain reaction leading to the destruction of energy and Life as we know it. A depleted soil begets our foods lack of nutrients. Food without proper mineralization begets bodies that lacking the energy and minds lacking the clarity to live a fulfilling life……Statistics from the USDA reveal that today’s food has 30-70% less nutritional value than food 50 years ago…..An unhealthy soil grows unhealthy plants.” from Son of a farmer, child of the earth, by Eric Helm, pg. 104-5.

Our Third Mini-Medical School asked the question-Is some “organic” better than others? The answer was a resounding YES. The Washington Post recently published an expose of the organic factory dairies. In addition to data collection and aerial photography, they also compared the composition of the milk to conventional, non-organic milk. In this analysis, organic factory farm milk was essentially identical to non-organic milk, despite commanding a premium price.The full story can be found at: https://www.washingtonpost.com/business/economy/why-your-organic-milk-may-not-be-organic.

In an effort to level the playing field, the Organic Animal Welfare Standards were finalized under the Obama administration, but implementation has been delayed by the current administration. The USDA requested an additional public comment period and this was completed today, June 9, 2017. The improved regulations will clarify overly broad definitions and guidelines. For example, chickens labelled “cage-free, organic”can be running in a grassy pasture or spend their entire life in large buildings. They are un-caged, but certainly not “free range”. While we wait for better regulations, you can use the Cornucopia scorecard results that follow to guide your shopping.

The following chemistry lesson reviews three key markers of good organic animal products in the essential fatty acid family, and then lists candid recommendations for consumers. The scorecard was accessed at Cornucopica.org June 2, 2017.

Health benefits of LA: heart disease. Note ratio of Omega 6/3 is important. Historically this was 1:1 and now is 10:1.

Current Private Party labeling standards for pastured ruminants:

American Grass-fed Certification: Diet — Animals are fed only grass and forage from weaning until harvest. Confinement — Animals are raised on pasture without confinement to feedlots.
Antibiotics and hormones — Animals are never treated with antibiotics or growth hormones.
Origin — all animals are born and raised on American family farms.

The Union of Concered Scientists (UCS) reviewed 13 studies on Fatty acid composition of beef. Here are the conclusions:
Total fat was significantly lower in pastured (grass-fed) beef.
Pastured beef has higher levels of ALA, EPA/DHA and CLA. The Ration of Omega 6/3 is more favorable in pastured beef.

Is it possible to consume meat and dairy in a way that is good for the environment?

Recent research on soil remediation shows that rotation grazing and careful management of ruminants actually improves soil quality and that healthy soil can trap significant quantities of atmospheric carbon. California has initiated a Healthy Soils initiative which will be implemented in the late fall of 2017. This will bring the research directly to ranchers and provide an incentive for conservation practices.

Here are pertinent general references if you wish more in depth coverage or research data support:

Books-The references in each book are most edifying.Herm, Eric. Son of a Farmer, Child of the Earth: A path to Agriculture’s Higher Consciousness. Dreamriver Press, 2010.

Miller, MD, Daphne. Farmacology: What Innovative family farming can teach us about health and healing Harper-Collins, 2013.

Salatin, Joel. Folks, this ain’t normal: A farmer’s advice for happier hens, healthier people and a better World. Hatchett, 2011.

Gibbons, Euell. Stalking the Wild Asparagus: Fiftieth Anniversary Edition. Alan Hood & Co., 1960. This is a favorite book, but be careful wildcrafting plants as they may be sprayed with herbicide. Only highly experienced persons should ever gather mushrooms. We have several poisonings annually and some are fatal. This includes your dogs!

Producers in this top tier manage diverse, small to medium-scale family farms. They raise their hens in mobile housing on well-managed and ample pasture or in ﬁxed housing with intensively managed rotated pasture. They sell eggs locally or regionally under their farm’s brand name, mostly through farmer’s markets, food cooperatives and/or independently owned natural and grocery stores and sometimes through larger chains like Whole Foods.Stueve’s Certified Organicby Stueve’s Certified OrganicRedhill Farms
by Vital Farms

Producers in this category provide ample outdoor space and make an eﬀort to encourage their birds to go outside. They provide an excellent outdoor environment, often either rotated pasture or well-managed outdoor runs, with an adequate number of popholes/doors for the chickens to reach the outdoors.Mary’s Organic Eggs
by Pitman Family Farms

Brands with a three-egg rating are very good choices. Eggs from brands in this category either come from family-scale farms that provide outdoor runs for their chickens, or from larger-scale farms where meaningful outdoor space is either currently granted or under construction. All producers in this category appear committed to meeting organic standards for minimum outdoor space for laying hens.Happy Egg
by Noble Foods

These are either industrial-scale operations or others with outstanding questions or concerns regarding their compliance with USDA regulations. One of the primary features that distinguish these organizations from the ethically challenged brands below is their willingness to share with their customers (and Cornucopia researchers) some of the details as to how their chickens are cared for and how their eggs are actually produced.Clover Organic
by Clover

Brands with a “1-egg” rating are generally produced on industrial-scale egg operations that grant no meaningful outdoor access. “Outdoor access” on these operations generally means a covered concrete porch that is barely accessible to the chickens. Means of egress from the buildings are intentionally small to discourage birds from going outside, and make it possible for only a small percentage of birds to have “access” to the outdoors. No producers in this category were willing to participate in The Cornucopia Institute’s project, and none shared their production practices with Cornucopia researchers. This is disturbing to many organic consumers, since transparency has always been viewed as a hallmark of the organic food movement.Alta Dena
by Dean FoodsBarnstar Family Farms
by NucalGlaum Egg Ranch
by Glaum Egg RanchJudy’s Family Farm
by Petaluma FarmsNaturally Organic
by National Food Corp“1-Egg” Rating (Private Label) 0-1000
Private‐label, or store‐brand, eggs rated with one egg are sold by grocers or distributors who have the obvious desire of wanting to grow their presence in the organic marketplace. Unfortunately, there is an inherent limitation in private‐label organic products: organic consumers tend to want to know where their food is coming from and how it is produced, and private‐label products are anonymous by their very nature. Our research indicates that the vast majority of organic eggs for private label brands are produced on industrial farms that house hundreds of thousands of birds and do not grant the birds meaningful outdoor access.365 Organic
by Whole FoodsArcher Farms
by TargetClearly Organic
by Associated Wholesale GrocersCountry Creek
by WalmartKirkland Signature
by CostcoO Organics
by SafewayTrader Joe’s by Trader Joe’s

Between stimulus and response there is a space.
In that space is our power to choose our response.
In our response lies our growth and our freedom.
Viktor E. Frankl

Mindfulness is attending to the present. There is nothing foreign, difficult or exotic about mindfulness. Mindfulness as applied to stress reduction is the most widely known practice, and was developed in the 1970s by Jon Kabat-Zinn at the University of Massachusetts Medical Center. It is, at its heart, a meditation practice that can be learned and used by anyone. It was initially applied in medical settings with excellent results on depression, anxiety and fear of disease recurrence.
Mindfulness means attending to your current internal and external perceptions. This is greatly facilitated by attending to breathing. Here is a three minute body scan meditation:

Begin by bringing your attention into your body. You can close your eyes if that’s comfortable for you. You can notice your body seated wherever you’re seated, feeling the weight of your body on the chair, on the floor. Take a few deep breaths. And as you take a deep breath, bring in more oxygen enlivening the body. And as you exhale, have a sense of relaxing more deeply. You can notice your feet on the floor, notice the sensations of your feet touching the floor. The weight and pressure, vibration, heat. You can notice your legs against the chair, pressure, pulsing, heaviness, lightness. Notice your back against the chair. Bring your attention into your stomach area. If your stomach is tense or tight, let it soften. Take a breath. Notice your hands. Are your hands tense or tight? See if you can allow them to soften. Notice your arms. Feel any sensation in your arms. Let your shoulders be soft. Notice your neck and throat. Let them be soft. Relax. Soften your jaw. Let your face and facial muscles be soft. Then notice your whole body present. Take one more breath. Be aware of your whole body as best you can. Take a breath. And then when you’re ready, you can open your eyes.
From www.mindful.org

Mindfulness based exercises are currently applied in a wide variety of settings.

The Mindful Athlete: Secrets to Pure Performance by George Mumford, who was the mindfulness coach for the Chicago Bulls Basketball team.
Here are his three principle points in quotes taken from Mindful Feb 2016, pg. 47-54 written by Hugh Delehanty, www.mindful.org:“Be still and know”: Mumford learned the power of stillness from Tai Chi practice. “When the mind is still you have an inner knowing when and how to strike.” This has also been describes as being in the flow.Forget Yourself, Find Yourself: “not how you are doing but what are you doing.”

Introduction: The basis of integrative health is the harmonious union of mind, body and spirit. An additional essential component is the health of the environment and of our socio-political system. We are in a time of rapid evolution, and it is in our best interest to understand these processes in depth and to act for positive outcomes. Medicine is no exception, and this Mini-Medical School provides basic tools for understanding healthcare USA.

Providers:

Physicians– Degree is M.D or D.O., and they are the only provider that can use the designation “Physician”. Four years of Medical School after College. Average debt from medical school alone is $170,000. In order to enter private practice, a residency is mandatory. Duration of this apprenticeship is 3-8 years depending on specialization and pay is $50-60,000/year for a 100-140 hour work week. Specialty board examinations are required, and maintenance is mandatory. Physician salaries are proportional to specialty. The ability to perform procedures dramatically increases income. Average duration of office visits is 15-20 minutes.

Naturopathic Doctors-Degree is N.D. Usually four years of Naturopathic School after four years of college. No residency required to practice. Bastyr (Seattle) is the best followed by Southwest College (Tempe, Ariz) and The National College of Naturopathic Medicine in Portland. Licensing varies by state.

Nurse Practitioner-Degree is R.N., N.P. and requires 4 years of nursing school (after high school), and 1-3 year Masters level training. They function semi-independently.

Physician’s Assistant-Degree is P.A. and certification usually requires 2 years after a four year college. PA’s require direct physician supervision, physically or by electronic communication.

Midwife-Certified Nurse Midwives (CNM) are registered nurses who have taken additional training. They are regulated by the California Board of Registered Nurses. Certified professional midwives/licensed midwives complete a three year post-secondary program in an approved midwifery school and pass the licensing exam. Licensed midwives are regulated by the Medical Board of California.

Payers:

Insurance-Persons under age 65 are usually insured through their employer. The rest are in the “individual” insurance market. State supported insurance in California is called MediCal. At 65, citizens who have qualifying earnings may have Medicare. Thirty million remain uninsured.
The cost of your premium is not everything: Your cost out of pocket depends on your deductible, formulary and covered benefits.

Medicare– It is not as complex as it appears:

Part A- Hospitalization. Funded primarily by payroll taxes
Part B-Doctor’s fees and visits. Funded by general revenues and premiums.
Part C- Medicare Advantage (combines A, B and D)
Part D- Drug Plan. Funded by general revenues and premiums.
Supplemental-Covers to 20% that Medicare does not pay.

Medicare is more financially stable since the passage of the Affordable Care Act (ACA/Obamacare), and is currently solvent until 2028. Repealing the ACA would increase Medicare spending by $802 billion over 10 years. People over 80 account for most of the spending. Prescription drug coverage is projected to grow faster than any other cost segment.

Formulary– A list of drugs covered by your plan. Your cost depends on the Tier of the drug, usually 1-5. This changes annually. You are mailed a copy annually and it is vital that you keep this accessible for reference as your needs change. Your doctor does not have access to your formulary.

The Explanation of Benefits (EOB) is an important report generated when you have a billed medical expense and you must understand and save the form or be able to access it on line. Here is an example:

Claim date and provider

Billed Amount

Allowed Amount

Non-Allowed Amount

Applied to Deductible

Paid Amount

Remark Code

11/11/2016

LabCorp

300.00

100.00

200.0

50.00

50.00

230

Changes to Healthcare considered: The Affordable Care Act instituted many positive and popular reforms: Children on parents insurance until 26, no exclusion for prior conditions, no retroactive cancellations, subsidies for low income, increased coverage for preventive services, contraceptive and maternity coverage. There are also effects on Medicare, specifically closing the Doughnut hole. There are over a hundred subprograms of the ACA and any changes will affect the entire structure. An excellent summary of the current ACA and the Ryan and Price plans are available at the Kaiser Family Foundation Site.

During our discussion, the rising cost of health care attributable to administrative fees was identified as a key concern. Corporations are required to articulate a primary duty to their shareholders to maximize financial return on investment. A suggestion was made to require insurance companies to be structured as B Corporations. In California, B Corps received legal status in 2012. Rather than shareholder profit, the B Corp primary duty is to create general public benefit. Further information can be found at:

Avoiding Weight Gain-it is not what you think.
Mini-Medical School #6 2016

Stephanie Taylor MD PhD

The holiday season is a very special time of the year and there are very special foods associated with holiday celebrations. Most celebration foods are high-calorie and many of us worry about weight gain during the holiday season. Traditional cookies are gingerbread, Pfefferneuse, Springerle, Lebkuchen, Pizelle, Spitzgeback, Repostria and Tirggel. Tirggel has been a traditional holiday food since the third millennium BCE. All of these are wheat based and high fat foods. The calorie count alone is enough to make you fret but in our complex contemporary society, today’s cookie is not the same treat it was just 100 years ago.

The world is experiencing a dramatic increase in body weight. Surveys comparing 1982 body weight to 2008 body weight show a doubling of obesity in adults and tripling in children. There are 100 million obese adults in the United States and 25.8 million adult onset diabetics. The incidence of diabetes is rapidly increasing.

Just how do you gain weight? You need to consume 3500 calories to gain 1 pound. To gain 100 pounds you need to consume an additional 350,000 calories or 1500 candy bars, or an additional 500 calories a day for 700 days. The observed increase in obesity does not directly match the increase in caloric intake, leading to an investigation into other causes of the obesity epidemic. In 2006, researchers at UC, Irvine discovered and named a class of chemicals which they call Obesogens. Obesogens cause weight gain not attributable to increased calories, exerting their metabolic effects on multiple pathways. They prevent mobilization of fat stores for energy and give directions to increase fat deposition. Obesogens also change metabolic set points which determine your body’s ideal weight or fat percentage. Even more concerning, animal studies show that these changes can pass through to subsequent generations.

You can be exposed to Obesogens from many sources, some quite unexpected. A common source is food and water. Obesogens are fat soluble and accumulate in animal and fish fat, especially if animals are fed non-organic feeds. Plastics and can linings can leach chemicals into food. Many herbicides and pesticides are obesogens. Another very common exposure is house dust. Household dust contains flame retardants from foam furniture, and degrading plastic from kitchen appliances and computers. Spraying of agricultural fields exposes children and adults to drift. Obesogenic air pollutants include auto exhaust, and particulates from the road and burning fuels. Many chemicals can be absorbed through the skin, and are present in cosmetics, skin products and household cleaners. In addition to the weight gain issue, many of these chemicals, especially glyphosate, are linked to other very serious diseases: diabetes, autism, neurological degeneration of all types, osteoporosis, atherosclerosis, mitochrondrial damage and chronic fatigue, overgrowth of pathogenic gut bacteria, infertility and even prion diseases.

This last chemical, glyphosate is more familiar as an ingredient in the herbicide, Roundup. Exposure to glyphosate has dramatically increased since 1975, and especially with the recent adoption of pre-harvest spraying. In the last 10 years, 2.4 Billion pounds of Roundup have been used in the USA. Roundup is used on all GMO (genetically modified) crops, and also non-GMO crops to facilitate the harvest processing. . In the USA, 93% of all soybeans, and 89% of all corn crops are genetically modified. Additional staple foods that are usually GMO are cotton, sugar beets and canola. These basic foods are processed into other common ingredients such as canola oil, high fructose corn syrup, and beet sugar. They are incorporated into about ¾ of all processed foods. Non-GMO grains which are sprayed pre-harvest are: wheat, oats, barley and other grains. Purchasing a grain labelled Non-GMO does not protect you from glyphosate exposure. The label must state the grain is produced organically. Unfortunately, even organic foods are contaminated with glyphosate due to groundwater contamination and drift. Roundup cannot be removed by washing or peeling. It is incorporated into the body of the plant.

Weeds are smart and are increasingly resistant to Roundup. The newer Roundup and herbicide formulations include 2,4-D ( a primary ingredient in Agent Orange) and dicamba which are even more toxic. It is also important to know that the dose does not make the poison. Endocrine disruptors are active at doses much lower than specified toxic levels, and over a longer period of time. These low doses and long durations are not included, nor required, in most applications for safety certification.

Prudent Avoidance

Eat Organic, including the feed for the chickens, dairy cows and meat animals.
Vacuum a lot.
Read labels and reject products with unfamiliar chemical names OR “Fragrance”.
Remember “Natural” has no legal meaning.

The Cornucopia Institute. The Cornucopia Institute engages in educational activities supporting the ecological principles and economic wisdom underlying sustainable and organic agriculture. Through research and investigations on agricultural issues, The Cornucopia Institute provides needed information to consumers, family farmers, and the media. The Cornucopia Institute is recognized by the IRS as a tax-exempt 501(c)(3) public interest group. Donations are tax-deductible to the full extent of law. Access at: https://www.cornucopia.org/

Attend the EcoFarm Conference held at Asilomar Conference Center in late January. Single day tickets are available, and you do not need to be a farmer to attend. One of the biggest thrills of EcoFarm is seeing the large number of young people participating.

More than twenty years ago Dr. William Dement gave a Community Hospital Grand Rounds on Sleep Medicine. Dr. Dement is one of the founders of the field. At the time it was new and without much professional recognition. His efforts to convince the Traffic Safety officials that drowsy driving was as dangerous as drunk driving met with no success. Somewhat disheartened and at the end of a long day, he settled into his back yard with a beverage to contemplate his next step. Within a few minutes, a car crashed through his fence and safely came to rest in his yard. The driver had, of course, fallen asleep at the wheel. This event was a bit misplaced, since he, himself, did not need convincing, but rather the local officials down the road. It does make a good teaching point, however, as we now have a greater appreciation of the risks of sleep deprivation to both airline and road traffic safely. There has been significant progress since Dr. Dement’s backyard incident. In 2010, the National Transportation Safety Board appointed its first trained sleep scientist, Dr. Mark Rosekind. In 2003, the accrediting agency for graduate medical education approved Sleep Medicine as a formal training program.

Sleep medicine is a vast topic, and this essay will be an introduction to the field with some helpful practical advice.

The two most common sleep complaints are sleep apnea and insomnia.

Sleep apnea (OSA) is defined as the cessation of regular breathing during sleep, usually attributable to a collapse of the airway. The prevalence is variable and can be as high as 20% of the general population. The health risks associated with sleep apnea are: daytime sleepiness, heart failure, hypertension, lung disease, obesity, stroke, depression, and diabetes. Associated morbidities are decreased work performance and an increase in work and leisure time injuries. The cost of untreated OSA is high with OSA related traffic accidents alone reaching $15.9 billion and 1400 lives in the year 2000. OSA is successfully treated with positive pressure ventilation or dental appliances. The difficulty is in getting individuals in to be diagnosed and treated. Common questions on diagnostic questionnaires are: Do you snore? Is your snoring loud? Does your bedpartner notice you not breathing or gasping during sleep? Have you fallen asleep during the day? Do you have high blood pressure?

Insomnia is even more common than OSA. The incidence varies depending on the severity, ranging from 20-40% of adults. Insomnia is commonly treated with oral prescription medications. In the last year surveyed, 2011, there were 60 million prescriptions written, amounting to $3.7 billion in sales. Alcohol is also commonly used for relaxation and will induce sleep, but there is usually a recurrence of insomnia between 1 and 3 AM. Taking a sleeping pill regularly is not a solution. Most sleep medications can induce dependence, both psychological and physical. Furthermore, the quality of medication induced sleep is uncertain and is the subject of much research.

Some think it is fashionable to brag about not needing much sleep. This brag is unwise. There is a newly discovered mechanism in the brain called the glymphatic system. It seems to be the “trash collector” for the brain and is most active during sleep. Part of that trash includes beta-amyloid, which is associated with the development of Alzheimer’s disease. It is possible that deliberate reduction of sleep duration will increase risk of dementia. Indeed, the diagnosis of dementia is often preceded by several years of sleep disorder.

There are many more sleep disorders, but OSA and insomnia are the most common and familiar. Here are some practical suggestions for better sleep.

The ideal sleep duration is different for individual adults, but is 7-8 hours is ideal. If you suspect sleep apnea, that requires evaluation by a sleep specialist, but occasional insomnia will respond to home remedies. Pre-sleep preparation is very important. Here are some basic tips:

Minimize stimulants after 2 PM. That would include caffeinated beverages and some nasal decongestants. Do not exercise or eat within 3 hours of bedtime. There is clear association of poor sleep quality and use of cell phones, computers and pads before bed. Not only is the information stimulating, but the blue light prevents the normal release of sleep inducing neuro-chemicals. There are some pads that have a blue filter scheduled to apply at 8 PM, and these are worth investigating if you need to keep working in the evening.

Psychological issues-tension and stress. Avoid stressful activities before bed. This would include listening to the evening news, paying bills, arguments and general worry. You are not going to get anything solved between midnight and 7 AM, so just let it go for the evening.

Plan to go to sleep and arise at a regular time each day. This help train your body to a regular cycle. Stop eating 3 hours before you plan to go to bed. If your gut is busy, your brain will not have a chance to relax. If you get home late and need to eat, try something very light and digestible.

If you are having difficulty sleeping, stop trying after 30 minutes, and leave the bed and do something relaxing, and not computer based. Reading with a small focused light is helpful. Too much illumination will reduce the neuro-chemicals that are needed to induce sleep. If you are fretting, try writing down your worries. You can keep a self-illuminating pen and journal near the bed.

Your best sleep environment is a dark room with no disturbing noises. Background white noise or a HEPA air filter are soothing. Electromagnetic fields are not helpful to sleep, and you should be 8 feet away from those fields. You can assess your environment with a Tri-field meter, and common sources are clock radios, cell phones and computer screens.

Your bed should be a source of comfort, and good mattress, bed linens and blankets contribute to a positive sleep experience. Ariana Huffington wrote a lovely book called The Sleep Revolution that I highly recommend. There is a great list of sleep friendly hotels in the back. Very handy for your next travel adventure. Her TED talk is available at: https://www.ted.com/talks/arianna_huffington_how_to_succeed_get_more_sleep?language=en

Supplements that help sleep are very popular and fairly effective. You may need to try several before you find the right combination for your own chemistry. These are sold over the counter, and like all OTC supplements, you need to be sure you are buying good quality. Popular herbs are Valerian, ashwaganda and passion flower. Supplements that are also effective and safe are glycine, taurine, magnesium, l-theanine and melatonin. If you are on antidepressants, do not take 5-HTP for sleep as it would be contraindicated, but it is otherwise helpful.

Classes and Workshops

Highlighted Events:

Mini-Medical School 2018 We are now meeting at the Unitarian Universalist Church of the Monterey Peninsula, 490 Aguajito Road, Carmel, CA. We meet the first Saturday of even numbered months (except for October) from 1:30 to 2:30 PM.Dates for 2018 are: Jan 20, Medical GeneticsApril 7, Building a Home Herbal Cabinet June 2, The Wheat of Our Ancestors Aug 4, Inside the Disinformation Playbook Oct 13, Genetic Genealogy with Dr. Barbara Rae-VenterDec 1, Genetics Part 2 Bring your questions and your friends!.

Tai Chi 24 Form Yang Style will start Jan 6, 2018. The final 24 Form class of the spring will be May 19th, 2018. A new Essentials Class will start June 23, 2018 and end Sept 29, 2018. Focus will be on Tai Chi Principles using Silk Reeling exercises as primary practice. This class will help prepare you for the October 13-14, 2018, Silk Reeling Workshop. This class is appropriate for both beginners and experienced practitioners. After the Silk Reeling Workshop, regular classes will resume Oct 20, 27, Nov 3, 10, 17, Dec 1, 8, 15, 2018.Tai Chi classes are held in Pacific Grove at 10:30 AM, Saturdays. Call 831-622-1994 for more information and to register.

Silk Reeling Workshop with Sifu Dan Jones. This will be a two day workshop Oct. 13-14, 2018. Call 831-622-1994 for questions and registration.Preregistration required for Tai Chi Classes and Workshops.

Call us at 831-622-1994 to register for Tai Chi Classes and for general information on Tai Chi or the Mini Medical School.

Use your own good judgment in dealing with any merchants or associations linked to this website. These sites are chosen for their commitment to the common good, but Stephanie Taylor cannot indemnify (or take responsibility for) problems with others' actions.